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S. V. Subramanian, PhD; Leland K. Ackerson, ScD; George Davey Smith, MD, DSc; Neetu A. John, ScM

JAMA. 2009;301(16):1691-1701.

Context  Prior research on the determinants of child health has focused on contemporaneous risk factors such as maternal behaviors, dietary factors, and immediate environmental conditions. Research on intergenerational factors that might also predispose a child to increased health adversity remains limited.

Objective  To examine the association between maternal height and child mortality, anthropometric failure, and anemia.

Design, Setting, and Population  We retrieved data from the 2005-2006 National Family Health Survey in India (released in 2008). The study population constitutes a nationally representative cross-sectional sample of singleton children aged 0 to 59 months and born after January 2000 or January 2001 (n = 50 750) to mothers aged 15 to 49 years from all 29 states of India. Information on children was obtained by a face-to-face interview with mothers, with a response rate of 94.5%. Height was measured with an adjustable measuring board calibrated in millimeters. Demographic and socioeconomic variables were considered as covariates. Modified Poisson regression models that account for multistage survey design and sampling weights were estimated.

Main Outcome Measures  Mortality was the primary end point; underweight, stunting, wasting, and anemia were included as secondary outcomes.

Results  In adjusted models, a 1-cm increase in maternal height was associated with a decreased risk of child mortality (relative risk [RR], 0.978; 95% confidence interval [CI], 0.970-0.987; P < .001), underweight (RR, 0.971; 95% CI, 0.968-0.974; P < .001), stunting (RR, 0.971; 95% CI, 0.968-0.0973; P < .001), wasting (RR, 0.989; 95% CI, 0.984-0.994; P < .001), and anemia (RR, 0.998; 95% CI, 0.997-0.999; P = .02). Children born to mothers who were less than 145 cm in height were 1.71 times more likely to die (95% CI, 1.37-2.13) (absolute probability, 0.09; 95% CI, 0.07-0.12) compared with mothers who were at least 160 cm in height (absolute probability, 0.05; 95% CI, 0.04-0.07). Similar patterns were observed for anthropometric failure related to underweight and stunting. Paternal height was not associated with child mortality or anemia but was associated with child anthropometric failure.

Conclusion  In a nationally representative sample of households in India, maternal height was inversely associated with child mortality and anthropometric failure.

Author Affiliations: Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts (Dr Subramanian and Ms John); Department of Community Health and Sustainability, School of Health and Environment, University of Massachusetts, Lowell (Dr Ackerson); and MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, England (Dr Davey Smith).

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